Wolf-Hirschhorn (WH) syndrome is a rare chromosomal abnormality with deletion of the short arm of chromosome 4. Associated clinical signs and symptoms of the condition include intrauterine growth restriction, severe psychomotor retardation, failure to thrive, characteristic facial features, profound developmental delays, seizures, and various congenital midline fusion anomalies. Given the associated congenital anomalies, anesthetic care may be required for various surgical interventions. We report a 3-month-old girl with WH syndrome scheduled for gastrostomy tube placement. Previous reports of anesthetic care for such patients are reviewed and potential perioperative concerns are discussed.